Emergency Drugs · Recombinant tissue plasminogen activator
Alteplase (tPA — STEMI)
Dose
STEMI: 15 mg IV bolus, 50 mg over 30 min, 35 mg over 60 min (max 100 mg). Stroke: 0.9 mg/kg (max 90) — 10% bolus, remainder over 60 min.
Mechanism
Converts fibrin-bound plasminogen to plasmin → clot lysis.
Indications
- • STEMI <12 h when PCI unavailable ≤120 min
- • Ischaemic stroke <4.5 h
- • Massive PE with haemodynamic instability
Contraindications
- • Prior ICH
- • Ischaemic stroke <3 months
- • Active bleeding
- • Recent major surgery/trauma
- • BP >185/110 uncontrolled
- • Aortic dissection suspected
Dilution & preparation
50 mg vial reconstitute to 1 mg/mL
Use
Fibrinolysis when timely PCI unavailable.
Monitoring
Neuro obs, BP, bleeding, ECG for reperfusion arrhythmias.
Side effects
- • Bleeding
- • ICH (~1% STEMI, 6% stroke)
- • Angio-oedema (with ACEi)
- • Reperfusion arrhythmias
Related in WardRound
STEMI
Protocol · PPCI < 120 min
Stroke
Protocol · Time is brain — FAST
Pulmonary Embolism
Protocol · PESI / Wells
Massive Pulmonary Embolism
Protocol · Haemodynamic instability + suspected PE
Empyema / Complicated Parapneumonic Effusion
Protocol · Drain + antibiotics
Stroke (Ischaemic)
Topic · Neurology
Acute Ischaemic Stroke
Topic · Neurology
Always confirm dose against your local formulary / BNF before prescribing.
